November 21, 2022

What Matters Now in Washington:

  • Midterm elections yield unclear results for year-end legislating. More…
  • In a first, the Food and Drug Administration determined the risks to child health posed by a menthol e-cigarette outweighed any potential benefits to adult smokers when it denied a marketing application for Logic menthol e-cigarettes. More…
  • Following a decade of advocacy, the federal government finalized a rule to fix a loophole that has prevented hundreds of thousands of families from qualifying for health insurance subsidies under the Affordable Care Act. More…
  • The “unwinding” of the public health emergency may lead to children losing Medicaid coverage, largely due to procedural reasons. More…
  • The federal government is continuing work to implement the Pediatric Subspecialty Loan Repayment Program, while the PPC advocates for additional funding. More…
  • See what other developments we’re tracking with implications for child health advocacy. More…
  • Find new funding opportunities, research findings, and more below. More…
  • PPC members authored policy commentaries in Pediatric Research exploring the intersections of child health policy, advocacy, and pediatric research. More…

Muddy Midterm Outcome Leaves Prospects for Lame Duck, New Congress Unclear. The unexpected results of Tuesday’s midterm elections have scrambled expectations about Congress’s year-end priorities as the partisan composition of both chambers will be narrowly split. With Republicans and Democrats watching key House and Senate races that have yet to be called, the political calculus about how best to use the remainder of the year and how to approach the upcoming Congress may yet shift dramatically.

Despite predictions of a decisive victory vaulting Republicans into a sizable House majority, Democrats outperformed expectations and held back an anticipated red wave. Republicans ultimately won the House more than a week after Election Day after clinching the 218 seats required to form a majority. However, the Republican majority will be far narrower than anticipated; with four races yet to be called, the partisan split in the House may ultimately be as narrow as 219 Republican seats to 216 Democratic seats. Further, a small margin in the House looks likely to cause trouble for House Minority Leader Kevin McCarthy (R-Calif.), who may need to make concessions to internal party factions to secure the speakership that could make governing more difficult. With few votes to spare, McCarthy would also face internecine struggles between moderates and conservatives.

Democrats retained control of the Senate after races in Arizona and Nevada were called in favor of incumbent Sens. Catherine Cortez Masto (D-Nev.) and Mark Kelly (D-Ariz.). Democrats also managed to flip one seat, electing John Fetterman to fill a Pennsylvania Senate seat previously held by a Republican. However, two more years of an evenly split chamber is entirely possible and will depend on the outcome of the Georgia runoff election between incumbent Sen. Raphael Warnock (D-Ga.) and Republican Herschel Walker. If Warnock prevails in his bid for reelection, Democrats would take an outright majority of 51 seats, which would allow them to avoid the power sharing arrangement they have been operating under with Republicans for the last two years and gain complete control over Senate Committees.

The uncertainty has made strategizing a challenge for both parties. Prior to the elections, most believed that Congress would focus its lame duck efforts on finishing work on year-end spending bill and annual national defense legislation, with both serving as potential vehicles for Congress to pass other priorities before the end of the year. However, expectations of a large Republican majority made it likelier that Republicans would force Congress to pass another short-term spending measure, allowing them to put their stamp on federal spending once in the majority next year. With the House Republican majority certain to be small, Republican leadership may be less likely to punt spending legislation to next year since a small number of fiscal conservatives could derail the process. A smaller majority would also decrease Republicans’ leverage next Congress, which may help move along legislation less popular with Republicans. While significant speculation remains, members of Congress on both sides of the aisle continue to watch closely as the remaining votes are counted.

 FDA Rejects Application for Menthol E-Cigarette to Protect Child Health. Late last month, the U.S. Food and Drug Administration (FDA) rejected an application from e-cigarette manufacturer Logic Technology Development LLC to sell its menthol e-cigarette products in the United States. The decision marks the agency’s first on a menthol-flavored e-cigarette – a significant victory for child health and an important step toward addressing epidemic levels of youth e-cigarette use.

In a statement, the FDA said the application was rejected because the company failed to submit sufficiently rigorous scientific evidence showing that the potential benefit to adult smokers outweighs the risks to youth.

The decision comes as FDA works to review a significant backlog of e-cigarette applications to determine if their sale is in the interest of public health. FDA’s yearslong failure to conduct this review allowed the market to be flooded with youth-appealing products and led a court to order FDA to act after pediatricians and public health organizations filed a lawsuit against the agency.

To date, the FDA has rejected thousands of applications for flavored e-cigarettes while authorizing the sale of a handful of tobacco-flavored products. Until this decision, the agency had not ruled on any menthol e-cigarette applications. The decision is a promising indicator that FDA recognizes that menthol, like all other flavors, is inherently youth-appealing and will closely scrutinize their sale in the U.S. Logic menthol products are now required to come off the market, though the decision is likely to be appealed in federal court by the manufacturer.

FDA also recently stepped up its enforcement against e-cigarette companies that have failed to undergo the premarket review requirement.

 Biden Administration Announces Finalized ACA Fix, Expanding Health Care Coverage. In October, the Biden administration finalized a rule to close a loophole in the Affordable Care Act (ACA) – known as the “Family Glitch” – that kept millions of people from qualifying for subsidized health plans. The action follows years of child health advocacy.

Currently, an employer-sponsored health insurance plan is considered “affordable” based on the cost of an individual health plan, not a more costly family plan. This glitch meant that many families were locked out of subsidized health coverage, instead paying an estimated 16 percent of their household income on employer-sponsored insurance premiums or going without coverage.

This final rule closes that loophole and is expected to help around 200,000 uninsured people gain coverage for the first time and lower the premiums for nearly a million families, particularly families of workers in the service industry, small business employees, and low-paid workers. The rule will go into effect later this year in time for open enrollment for 2023.

End of Public Health Emergency could Lead to Children’s Coverage Losses. Since March 2020, states have received enhanced federal matching funds conditioned on keeping Medicaid enrollees continuously enrolled for the duration of the public health emergency (PHE). When the PHE ends, state Medicaid agencies will be able to resume normal operations, including processing disenrollments, but will be required to redetermine the eligibility of all enrollees across the 14 months following the end of the PHE – a process being referred to as “The Unwinding.”  Medicaid experts caution that this process could result in significant coverage losses, largely due to procedural reasons. In August 2022, the HHS Assistant Secretary for Planning and Evaluation estimated that 5.3 million children may lose coverage, including 3.8 million who would still be eligible. The current PHE was renewed for 90 days in October and will now run to January 11, 2023.

Federal Government Continues WOrk to Implement Subspecialty Loan Repayment. The Health Resources and Services Administration is continuing work to implement the Pediatric Subspecialty Loan Repayment Program with initial funding provided in the Fiscal Year 2022 appropriations bill. The PPC will communicate additional details with academic pediatricians about the program’s launch as they are made available and continues to advocate for additional resources for the program in FY 2023.

What We’re Reading

Key Research Updates

PPC POLICY COMMENTARIES. Members of the PPC have authored commentaries detailing the policy implications of research published in Pediatric Research. You can read these PPC-authored commentaries online: